Adolescent alcohol use predicts cannabis use over a three year follow-up period

James G Linakis¹, Sarah A Thomas², Julie R Bromberg³, T Charles Casper⁴, Thomas H Chun^{1

3}, Michael J Mello^{1

3}, Rachel Richards⁴, Fahd Ahmad⁵, Lalit Bajaj⁶, Kathleen M Brown⁷, Lauren S Chernick⁸, Daniel M Cohen⁹, J Michael Dean⁴, Joel Fein¹⁰, Timothy Horeczko¹¹, Michael N Levas¹², B McAninch¹³, Michael C Monuteaux¹⁴, Colette C Mull¹⁵, Jackie Grupp-Phelan¹⁶, Elizabeth C Powell¹⁷, Alexander Rogers¹⁸, Rohit P Shenoi¹⁹, Brian Suffoletto¹³, Cheryl Vance²⁰, Anthony Spirito²; Pediatric Emergency Care Applied Research Network.

Affiliations

¹ Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³ Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
⁴ University of Utah, Salt Lake City, Utah, USA.
⁵ Emergency Medicine, St. Louis Children's Hospital/Washington University, St Louis, Missouri, USA.
⁶ Children's Hospital - Colorado, Aurora, Colorado, USA.
⁷ Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, Washington, D.C., USA.
⁸ Emergency Medicine, Columbia University Medical Center, New York, New York, USA.
⁹ Nationwide Children's Hospital, Columbus, Ohio, USA.
¹⁰ The Children's Hospital of Philadelphia, Philadephia, Pennsylvania, USA.
¹¹ Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA.
¹² Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹³ Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁴ Boston Children's Hospital, Boston, Massachusetts, USA.
¹⁵ Sidney Kimmel Medical College, Jefferson University/Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
¹⁶ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁷ Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
¹⁸ University of Michigan, Ann Arbor, Michigan, USA.
¹⁹ Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
²⁰ University of California of Davis, Davis, California, USA.

PMID: 34236277
PMCID: PMC8759759
DOI: 10.1080/08897077.2021.1949665

Adolescent alcohol use predicts cannabis use over a three year follow-up period

James G Linakis et al. Subst Abus. 2022.

. 2022;43(1):514-519.

doi: 10.1080/08897077.2021.1949665. Epub 2021 Jul 8.

Authors

Affiliations

¹ Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³ Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
⁴ University of Utah, Salt Lake City, Utah, USA.
⁵ Emergency Medicine, St. Louis Children's Hospital/Washington University, St Louis, Missouri, USA.
⁶ Children's Hospital - Colorado, Aurora, Colorado, USA.
⁷ Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, Washington, D.C., USA.
⁸ Emergency Medicine, Columbia University Medical Center, New York, New York, USA.
⁹ Nationwide Children's Hospital, Columbus, Ohio, USA.
¹⁰ The Children's Hospital of Philadelphia, Philadephia, Pennsylvania, USA.
¹¹ Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA.
¹² Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹³ Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁴ Boston Children's Hospital, Boston, Massachusetts, USA.
¹⁵ Sidney Kimmel Medical College, Jefferson University/Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
¹⁶ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁷ Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
¹⁸ University of Michigan, Ann Arbor, Michigan, USA.
¹⁹ Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
²⁰ University of California of Davis, Davis, California, USA.

PMID: 34236277
PMCID: PMC8759759
DOI: 10.1080/08897077.2021.1949665

Abstract

Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17 years old (n = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.

Keywords: Alcohol; adolescents; cannabis; emergency department; screening.

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Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to disclose.

Figures

**Figure 1:**
CUD = cannabis use disorder; PPV = positive predictive value; NPV = negative predictive value; AUC = area under the curve

See this image and copyright information in PMC

References

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Adolescent alcohol use predicts cannabis use over a three year follow-up period

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Adolescent alcohol use predicts cannabis use over a three year follow-up period

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Conflict of interest statement

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